Migraine Prevention: What You Can Do

When you’ve had the throbbing pain of a migraine, you want to do what you can to avoid another one.

If you get these headaches often or have severe ones, avoid the things that you know set them off, called triggers, like specific foods, smells, and alcohol, for example.

You might be able to keep migraines away with a couple other tactics, too:

  • Use preventive medications or devices.
  • Make lifestyle changes.

Preventive Migraine Medications

These meds can:

  • Help you have fewer migraines.
  • Make your headaches less severe.
  • Make them shorter.

This type of treatment can help if you get migraines often. Medications can reduce them by half or more.

You may want to consider preventive medications if:

  • The drugs you take to relieve your migraines don't help or you have bad side effects from them.
  • You have4 or more migraines a month.

The drugs that are used to prevent migraine include:

Anti-seizure drugs. These meds may work by calming nerve cells in the brain.

They include:

  • Topiramate (Qudexy XR,Trokendi XR Topamax)
  • Valproic acid (Depacon, Depakote, Stavzor)

Beta-blockers usually treat high blood pressure and heart disease. It's not clear how they help prevent migraines. But it may be because they improve blood flow. Some that work for these headaches include:

Antidepressants . These medications affect the level of the brain chemical serotonin, which may be linked to migraines. Some of them, such as amitriptyline and venlafaxine, can help keep the headaches away. Other kinds may work, too.

CGRP Inhibitors: CGRP (calcitonin gene-related peptide) is a molecule involved in causing migraine pain. CGRP inhibitors are a new class of drugs that block the effects of CGRP. Erenumab (Aimovig) is the first medicine specifically approved to prevent migraine attacks. You give yourself an injection once a month with a pen-like device. In clinical trials, people consistently had one to two fewer migraine days a month than those who took placebo. Mild pain and redness at the injection site are the most common side effects.

Triptans for menstrual-related migraines. These drugs treat migraines when they’re already happening, but one -- frovatriptan (Frova) -- may help prevent migraines that women get because of their menstrual cycle. The medicine affects serotonin levels and may also relieve pain in other ways.

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Botulinum toxin ( Botox ). Often used to treat wrinkles, it also helps some people who get migraines at least 15 days per month, called chronic migraines. It’s for people who have long-term migraine headaches, with the attack lasting 4 hours at a time or longer. Doctors think Botox may keep the brain from giving off chemicals that the body uses to send pain signals.

When you take medication to prevent migraines, keep these tips in mind:

  • Your doctor will likely start you on a low dose and gradually increase it over time. It may take several months to find the best dose with the fewest side effects.
  • Don't suddenly stop taking preventive medications. That could trigger a rebound headache. If you do need to stop taking them, you’ll need to gradually taper off under your doctor's care.
  • These meds probably won't completely get rid of your headaches. You may still need to take medicine when you do have one.

If you can't take medication or wish not to, a device might be worth considering. Cefaly is a portable headband-like device gives electrical impulses on the skin at the forehead. This stimulates a nerve associated with migraine headaches. Cefaly is used once a day for 20 minutes, and when it's on you may feel a tingling or massaging sensation.

SpringTM may be another option. You hold this device at the back of your head at the first sign of a headache, and it gives off a magnetic pulse that stimulates part of the brain. In addition, there is a noninvasive vagus nerve stimulator called gammaCore. When placed over the vagus nerve in the neck, it releases a mild electrical stimulation to the nerve's fibers to relieve pain.

Lifestyle Changes

Your everyday habits can go a long way to help you have fewer, less-severe migraines. Some things that may help include:

Sleep . Go to bed and get up about the same times every day, including on weekends and holidays. When you hit the sack at random times or you get too much or too little shut-eye, that can trigger a headache.

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Exercise regularly. You may be tempted to avoid being active, afraid it might trigger a migraine. Overdoing a workout may trigger a headache for some people, but research suggests regular, moderate aerobic exercise may make migraines shorter, less severe, and happen less often for many people. It also helps control stress, another trigger.

Eat regular meals. A drop in blood sugar can set off a migraine, so keep it steady by not skipping meals. Also, drink plenty of water to avoid dehydration, which can trigger the headaches.

Limit stress. Tension's a common trigger. So, take time each day to relax. You could:

  • Listen to calming music.
  • Take a short walk.
  • Meditate.
  • Do yoga.

Try complementary techniques. Along with your prescribed treatment, you might want to try one of these to help prevent migraines, such as:

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on May 22, 2017

Sources

SOURCES:

National Institute of Neurological Disorders and Stroke: "Migraine Information Page."

Silberstein, S. Neurology, April 24, 2012.

Migraine Research Foundation: "About Migraine."

National Headache Foundation: "Migraine Prevention: A Guide to the Latest Methods and Treatments."

Huntington J. American Family Physician, Oct. 15, 2005.

Epilepsy Action Australia: "Epilepsy and Migraine -- More than just a headache."

News release, FDA.

The Migraine Trust: "Botox for Migraine."

American Headache Society Committee for Headache Education (ACHE): "Preventive Treatments."

American College of Physicians: "Managing Migraine: How to prevent and control migraine headaches."

Silberstein, S. Neurology, Sept. 26, 2000.

University of Berkeley: "Guide to Managing Migraines."

Bastyr Center for Natural Health: "Exercise: A New Migraine Headache Therapy."

Varkey, E. Cephalalgia, 2011.

American Headache Society: "Headache Hygiene Tips."

National Center for Complementary and Alternative Medicine: "Headaches and CAM."

National Headache Foundation: "Migraine."

News release, FDA.

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